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Infectious and Inflammatory Causes of Acute Gastrointestinal Bleeding. In: Chung, P. and Kim, K.E. Acute Gastrointestinal Bleeding: Diagnosis and Treatment. Totowa, NJ: Humana Press. 2003. p. 151-161.

Most patients who present to their physician with a sudden onset of diarrhea have a benign, self-limited illness. Bloody diarrhea, on the other hand, requires a thoughtful and thorough evaluation. This chapter on infectious and inflammatory causes of acute gastrointestinal (GI) bleeding is from a textbook in which leading experts in the fields of gastroenterology, surgery, and radiology comprehensively review the pathophysiology, diagnosis, management, and treatment of acute bleeding disorders of the GI tract. The authors of this chapter discuss pathophysiology, clinical presentation, diagnosis, and treatment options. The authors note that acute bleeding from either infectious colitis or inflammatory bowel disease (IBD) can present in a similar manner. The presence of an infectious agent should not preclude the workup for IBD if the patient's history supports this as an additional diagnosis. A timely diagnosis is important for proper treatment strategies. Supportive care and early surgical consultation are important in severe cases. A patient care algorithm is included. 1 figure. 3 tables. 16 references.

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Lactose Intolerance Nutrition Guide. Chicago, IL: American Dietetic Association. 2003. 40 p.

Lactose intolerance is the incomplete digestion of lactose, a sugar that occurs naturally in milk and milk products. In people who are lactose intolerant, the body does not produce enough of the enzyme lactase to fully digest and absorb the milk sugar. As a result, lactose moves through the system undigested, leading to discomfort and symptoms such as gas, bloating, or diarrhea. This handbook offers suggestions and information for readers newly diagnosed with lactose intolerance. The handbook features tips for tolerating lactose-containing foods and beverages, how to recognize lactose content, instructions for finding milk substitutes and benefiting from soy foods, calcium recommendations, suggestions for infants and children, meal planning options, food offerings and companies, and recipes. Recipes are provided for creamy fresh herb dressing, orange nut bread, cream of mushroom soup, fettuccine Alfredo, macaroni and cheese, rich vanilla 'ice cream,' apricot sherbet, and raspberry chocolate pudding. A list of web sites for additional information is also provided. 1 figure. 3 tables.

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Lactose Intolerance. In: PDxMD. PDxMD Gastroenterology. St. Louis, MO: Elsevier Science. 2003. p. 369-385.

The inability to process lactose (milk sugar) is usually due to decreased amounts of lactase in the intestines, but other causes include small intestine mucosal disease, infections, and inherited lactase deficiency. Symptoms include flatulence (gas), bloating, nausea, cramps, abdominal pain, and diarrhea, usually within 30 minutes to 2 hours after intake of lactose-containing food or drinks. Diagnostic tests include a careful history, hydrogen breath test, stool acidity test, and very rarely small bowel biopsy. Treatment is simple and straightforward: avoidance of lactose-containing products usually results in symptom relief. This chapter on lactose intolerance is from a book on gastroenterology that offers concise, action-oriented recommendations for primary care medicine. The chapter covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Specific topics covered include the ICD9 code, urgent action, synonyms, cardinal features, causes (etiology), epidemiology, differential diagnosis, signs and symptoms, associated disorders, investigation of the patient, appropriate referrals and consultations, diagnostic considerations, clinical tips, treatment options, patient management issues, drug therapies, prognosis, complications, and how to prevent recurrence. The information is provided in outline and bulleted format for ease of accessibility. The final section of the chapter offers resources, including related associations, key references, and the answers to frequently asked questions (FAQs). 5 references.

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Lactose Intolerance. In: Bonci, L. American Dietetic Association Guide to Better Digestion. Hoboken, NJ: John Wiley and Sons, Inc. 2003. p. 140-154.

Coping with a gastrointestinal disorder, whether it is irritable bowel syndrome (IBS), gas (flatulence), constipation, heartburn, or another condition, can be embarrassing and debilitating. While medical treatments and prescriptions can offer relief, one of the most important ways patients can help themselves is in their dietary choices. This chapter on lactose intolerance is from a book that describes how patients can self-manage their digestive disorders through dietary choices. Lactose intolerance refers to the gastrointestinal symptoms (gas or bloating, diarrhea, abdominal pain) that can occur when there is not enough of the enzyme lactase to digest the lactose (milk sugar) in foods. Many people have lactose maldigestion, rather than true lactose intolerance. In this chapter, the author defines lactose intolerance and its various levels, then discusses the symptoms of the condition, problems that mimic lactose intolerance, the diagnostic tests that are used to confirm lactose intolerance, treatment options, the impact of dietary choices on lactose maldigestion, suggestions to improve tolerance of lactose-containing foods, and substitutions and modifications. The chapter includes lists of lactose-free foods, low lactose foods, and high lactose foods. 3 figures.

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Medical Approach to the Patient with Inflammatory Bowel Disease. In: Lichtenstein, G.R. The Clinician's Guide to Inflammatory Bowel Disease. Thorofare, NJ: SLACK Incorporated. 2003. p. 344-370.

Although the term inflammatory bowel disease (IBD) describes a wide range of inflammatory states, it generally refers to ulcerative colitis (UC) and Crohn's disease. The successful treatment of IBD requires careful attention to the patient's symptoms, with discrimination of which symptoms are due to IBD and which symptoms are due to separate disease processes. This chapter on the medical approach to the patient with IBD is from a handbook that presents an up to date guide on selected topics in IBD, focusing on those clinically important areas that have undergone recent changes or discoveries. In this chapter, the authors stress that key in the evaluation of patients with IBD is the identification of the location and severity of the disease. Treating IBD is a two-staged process: induction of remission, followed by maintenance of that remission. The authors review the general principles in the evaluation and management of symptoms suggestive of active IBD (including diarrhea, anorexia, nausea, vomiting, fever, or abdominal pain). Next, they discuss the management of specific clinical presentations of UC and Crohn's disease. Finally, a discussion of new therapies gives the reader insight into potential future treatment approaches. 4 figures. 4 tables. 25 references.

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Miscellaneous Diseases of the Small Intestine. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1663-1683.

This chapter on miscellaneous diseases of the small intestine is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. In this chapter, the authors note that the diseases discussed should be considered in patients presenting with gastrointestinal hemorrhage, abdominal pain, diarrhea, intestinal obstruction, or perforation that eludes diagnosis by routine gastroduodenal endoscopy and radiographic studies. Topics include ulceration of the small intestine, small intestine complications of drug therapy, necrotizing enterocolitis (NEC), and protein-losing gastroenteropathy (PLGE). Although most of these entities are infrequently encountered in clinical practice, differentiating them from diseases that are more common can yield important therapeutic benefits. For each condition, the authors discuss epidemiology and etiology, clinical features, pathology, diagnosis, and treatment. 6 figures. 3 tables. 361 references.

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Nutritional Support in Inflammatory Bowel Disease. In: Lichtenstein, G.R. The Clinician's Guide to Inflammatory Bowel Disease. Thorofare, NJ: SLACK Incorporated. 2003. p. 141-162.

Although the term inflammatory bowel disease (IBD) describes a wide range of inflammatory states, it generally refers to ulcerative colitis (UC) and Crohn's disease. This chapter on nutritional support in IBD is from a handbook that presents an up to date guide on selected topics in IBD, focusing on those clinically important areas that have undergone recent changes or discoveries. In this chapter, the authors note that multiple factors contribute to malnutrition in both Crohn's disease and UC. Reduced intake of food secondary to abdominal cramps, nausea, and diarrhea is a major cause of weight loss in IBD patients. Intestinal malabsorption also contributes to malnutrition in patients with active IBD. Nutrient deficiency can result in altered cellular immunity with increased risk of infection, delayed wound healing, and growth retardation in children. It is important to identify those patients who are at potential risk for malnutrition; management goals should then include correction of nutritional deficits. Choosing when to begin nutritional support and which method to use are also discussed in this chapter. 3 tables. 40 references.

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Pseudomembranous Colitis. In: PDxMD. PDxMD Gastroenterology. St. Louis, MO: Elsevier Science. 2003. p. 507-528.

Pseudomembranous colitis is an infection of the colon caused by Clostridium difficile. Overgrowth of C. difficile is a result of broad-spectrum antibiotic use. Clinically, C. difficile causes a wide range of disease severity ranging from severe pseudomembranous colitis, through antibiotic-associated diarrhea without colitis, to asymptomatic carrier state. This chapter on pseudomembranous colitis is from a book on gastroenterology that offers concise, action-oriented recommendations for primary care medicine. The chapter covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Specific topics covered include the ICD9 code, urgent action, synonyms, cardinal features, causes (etiology), epidemiology, differential diagnosis, signs and symptoms, associated disorders, investigation of the patient, appropriate referrals and consultations, diagnostic considerations, clinical tips, treatment options, patient management issues, drug therapies, prognosis, complications, and how to prevent recurrence. The information is provided in outline and bulleted format for ease of accessibility. The final section of the chapter offers resources, including related associations, key references, and the answers to frequently asked questions (FAQs). 5 references.

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Small Intestine: Infections with Common Bacterial and Viral Pathogens. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1530-1560.

This chapter on infections of the small intestine is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. In this chapter, the authors focus on the major bacterial and viral pathogens that infect the small intestine. Whether by toxin-mediated effects or direct destruction of intestinal epithelial cells, these microbial pathogens have devised ways to disrupt the normal fluid handling capabilities of the intestinal tract and cause diarrhea. In general, the diarrhea caused by infection with a small bowel pathogen is characterized by high-volume, less frequent bowel movements, whereas lower-volume and more frequent bowel movements are associated with colonic diarrhea. Topics covered include food poisoning and common source outbreaks, traveler's diarrhea, bacterial infection, viral pathogens, and therapeutic considerations. Specific organisms discussed include Clostridium perfringens, Listeria monocytogenes, Escherichia coli, Salmonella, Yersinia, Vibrio (including Vibrio cholera), Aeromonas, Plesiomonas, Edwardsiella, rotavirus, Norwalk and Norwalk-like caliciviruses, astrovirus, and enteric adenovirus. Treatment options discussed include oral rehydration therapy (ORT), antimicrobial therapy, antidiarrheal drugs, and enteric vaccines. 5 tables. 368 references.

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Surgery for Peptic Ulcer Disease and Postgastrectomy Syndromes. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1441-1454.

The surgical treatment of peptic ulcer is most frequently required when complications of previously unappreciated ulcers occur. This chapter on surgery for peptic ulcer disease (PUD) and postgastrectomy syndromes is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. The chapter covers elective surgery for PUD, surgery for duodenal ulcer, surgery for gastric ulcer, surgical treatment of peptic ulcer complications (hemorrhage, perforation, obstruction), and complications of the surgery for peptic ulcer, including recurrent ulcer, dumping syndrome, postvagotomy diarrhea, alkaline reflux gastritis, delayed gastric emptying, and gastric cancer. 13 figures. 3 tables. 132 references.

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